实用放射学杂志
實用放射學雜誌
실용방사학잡지
JOURNAL OF PRACTICAL RADIOLOGY
2010年
1期
77-83
,共7页
武春雪%王霄英%秦乃姗%郭丽%蒋学祥
武春雪%王霄英%秦迺姍%郭麗%蔣學祥
무춘설%왕소영%진내산%곽려%장학상
乳腺%乳腺癌%磁共振成像%新辅助化疗
乳腺%乳腺癌%磁共振成像%新輔助化療
유선%유선암%자공진성상%신보조화료
breast%breast cancer%MR imaging%neoadjuvant chemotherapy
目的 评估局部进展期乳腺癌患者在术前新辅助化疗(neoadjuvant chemotherapy,NAC)前后癌灶最大径、体积及两者的变化率对NAC病理反应性的价值. 方法 36例病例均根据术后病理反应性结果(Miller & Payne 分级)分为组织学显著反应(major histological response,MHR)与组织学非显著反应(non-major histological response,NMHR)2组,对2组NAC前、NAC第2周期后、NAC第4周期后于乳腺容积成像(volume imaging of breast,VIBRANT)动脉早期测量的癌灶最大径、体积及其变化率分别进行两独立样本t检验比较(非正态分布的数据进行Mann-Whitney U检验);采用Concordance correlation coefficient (CCC)分析3次MR测量的癌灶最大径与体积之间的一致性.利用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析判断MR测量的癌灶大小对NAC病理反应性的评估价值. 结果 NAC前后,MHR组3次MR测量的癌灶最大径 [(2.75±1.16) cm、(2.19±1.07) cm、(1.58±0.75) cm ] 及最大径第 1 次变化率[(21.70±15.09)%] 与 NMHR 组 3次最大径[(2.71±1.10) cm、(2.33±0.90) cm、(2.01±0.94) cm]及第1次变化率[(11.68±10.27)% ]均无统计学差异(P>0.05),但MHR组癌灶最大径第2次变化率[(39.00±15.38)% ]显著高于NMHR组[(25.83±21.77)%],差异有统计学意义(P=0.04).NAC前后,MHR组3次MR测量的癌灶体积[中位14.00 cm~3 (范围2.96～83.41 cm~3)、中位7.31 cm~3(范围0.05～55.35 cm~3)、中位2.69 cm~3(范围0～33.40 cm~3) ] 及体积第1次变化率[中位48.65%(范围33.64%～98.48%)]与NMHR组3次体积[中位4.25 cm~3(范围4.78～106.55 cm~3)、中位10.53 cm~3(范围1.72～42.85 cm~3)、中位7.56 cm~3(范围0.68～156.58 cm~3)]及第1次变化率[中位52.04%(范围-35.79%～78.31%)] 均无统计学差异(P>0.05),但MHR组癌灶体积第2次变化率[中位85.37%(范围27.52%～100%)]显著高于NMHR组[中位68.80%(范围-289.60%～94.24%)],差异有统计学意义(P=0.01).NAC前后,3次MR测量的最大径与体积之间的一致性系数分别为0.82、0.67、0.55,总体一致性系数为0.78.以NAC后癌灶最大径和体积第2次变化率为评估参数、术后病理反应性为金标准,ROC曲线下面积分别为0.75、0.80,两者评估效能无显著性差异(P=0.61). 结论 MR测量乳腺癌灶最大径与体积的一致性较好.NAC第4个周期后,癌灶最大径与体积两者的第2次变化率可评估癌灶对NAC的病理反应性,但评估效能均较低且无显著性差异.
目的 評估跼部進展期乳腺癌患者在術前新輔助化療(neoadjuvant chemotherapy,NAC)前後癌竈最大徑、體積及兩者的變化率對NAC病理反應性的價值. 方法 36例病例均根據術後病理反應性結果(Miller & Payne 分級)分為組織學顯著反應(major histological response,MHR)與組織學非顯著反應(non-major histological response,NMHR)2組,對2組NAC前、NAC第2週期後、NAC第4週期後于乳腺容積成像(volume imaging of breast,VIBRANT)動脈早期測量的癌竈最大徑、體積及其變化率分彆進行兩獨立樣本t檢驗比較(非正態分佈的數據進行Mann-Whitney U檢驗);採用Concordance correlation coefficient (CCC)分析3次MR測量的癌竈最大徑與體積之間的一緻性.利用受試者工作特徵麯線(receiver operating characteristic curve,ROC)分析判斷MR測量的癌竈大小對NAC病理反應性的評估價值. 結果 NAC前後,MHR組3次MR測量的癌竈最大徑 [(2.75±1.16) cm、(2.19±1.07) cm、(1.58±0.75) cm ] 及最大徑第 1 次變化率[(21.70±15.09)%] 與 NMHR 組 3次最大徑[(2.71±1.10) cm、(2.33±0.90) cm、(2.01±0.94) cm]及第1次變化率[(11.68±10.27)% ]均無統計學差異(P>0.05),但MHR組癌竈最大徑第2次變化率[(39.00±15.38)% ]顯著高于NMHR組[(25.83±21.77)%],差異有統計學意義(P=0.04).NAC前後,MHR組3次MR測量的癌竈體積[中位14.00 cm~3 (範圍2.96～83.41 cm~3)、中位7.31 cm~3(範圍0.05～55.35 cm~3)、中位2.69 cm~3(範圍0～33.40 cm~3) ] 及體積第1次變化率[中位48.65%(範圍33.64%～98.48%)]與NMHR組3次體積[中位4.25 cm~3(範圍4.78～106.55 cm~3)、中位10.53 cm~3(範圍1.72～42.85 cm~3)、中位7.56 cm~3(範圍0.68～156.58 cm~3)]及第1次變化率[中位52.04%(範圍-35.79%～78.31%)] 均無統計學差異(P>0.05),但MHR組癌竈體積第2次變化率[中位85.37%(範圍27.52%～100%)]顯著高于NMHR組[中位68.80%(範圍-289.60%～94.24%)],差異有統計學意義(P=0.01).NAC前後,3次MR測量的最大徑與體積之間的一緻性繫數分彆為0.82、0.67、0.55,總體一緻性繫數為0.78.以NAC後癌竈最大徑和體積第2次變化率為評估參數、術後病理反應性為金標準,ROC麯線下麵積分彆為0.75、0.80,兩者評估效能無顯著性差異(P=0.61). 結論 MR測量乳腺癌竈最大徑與體積的一緻性較好.NAC第4箇週期後,癌竈最大徑與體積兩者的第2次變化率可評估癌竈對NAC的病理反應性,但評估效能均較低且無顯著性差異.
목적 평고국부진전기유선암환자재술전신보조화료(neoadjuvant chemotherapy,NAC)전후암조최대경、체적급량자적변화솔대NAC병리반응성적개치. 방법 36례병례균근거술후병리반응성결과(Miller & Payne 분급)분위조직학현저반응(major histological response,MHR)여조직학비현저반응(non-major histological response,NMHR)2조,대2조NAC전、NAC제2주기후、NAC제4주기후우유선용적성상(volume imaging of breast,VIBRANT)동맥조기측량적암조최대경、체적급기변화솔분별진행량독립양본t검험비교(비정태분포적수거진행Mann-Whitney U검험);채용Concordance correlation coefficient (CCC)분석3차MR측량적암조최대경여체적지간적일치성.이용수시자공작특정곡선(receiver operating characteristic curve,ROC)분석판단MR측량적암조대소대NAC병리반응성적평고개치. 결과 NAC전후,MHR조3차MR측량적암조최대경 [(2.75±1.16) cm、(2.19±1.07) cm、(1.58±0.75) cm ] 급최대경제 1 차변화솔[(21.70±15.09)%] 여 NMHR 조 3차최대경[(2.71±1.10) cm、(2.33±0.90) cm、(2.01±0.94) cm]급제1차변화솔[(11.68±10.27)% ]균무통계학차이(P>0.05),단MHR조암조최대경제2차변화솔[(39.00±15.38)% ]현저고우NMHR조[(25.83±21.77)%],차이유통계학의의(P=0.04).NAC전후,MHR조3차MR측량적암조체적[중위14.00 cm~3 (범위2.96～83.41 cm~3)、중위7.31 cm~3(범위0.05～55.35 cm~3)、중위2.69 cm~3(범위0～33.40 cm~3) ] 급체적제1차변화솔[중위48.65%(범위33.64%～98.48%)]여NMHR조3차체적[중위4.25 cm~3(범위4.78～106.55 cm~3)、중위10.53 cm~3(범위1.72～42.85 cm~3)、중위7.56 cm~3(범위0.68～156.58 cm~3)]급제1차변화솔[중위52.04%(범위-35.79%～78.31%)] 균무통계학차이(P>0.05),단MHR조암조체적제2차변화솔[중위85.37%(범위27.52%～100%)]현저고우NMHR조[중위68.80%(범위-289.60%～94.24%)],차이유통계학의의(P=0.01).NAC전후,3차MR측량적최대경여체적지간적일치성계수분별위0.82、0.67、0.55,총체일치성계수위0.78.이NAC후암조최대경화체적제2차변화솔위평고삼수、술후병리반응성위금표준,ROC곡선하면적분별위0.75、0.80,량자평고효능무현저성차이(P=0.61). 결론 MR측량유선암조최대경여체적적일치성교호.NAC제4개주기후,암조최대경여체적량자적제2차변화솔가평고암조대NAC적병리반응성,단평고효능균교저차무현저성차이.
Objective To investigate the clinical value of tumor's longest diameter and volume in assessing pathologic response in locally advanced breast cancer treated with neoadjuvant chemotherapy(NAC).Methods A prospective study was undertaken in women undergoing NAC for locally advanced breast cancer in order to determine the ability of quantitative MRI to assess the final pathologic response. 36 cases with pathologically confirmed locally advanced breast cancer who had been undergone four courses of NAC underwent preoperative breast MRI three times during the NAC. Pathologic response was assessed according Miller & Payne grading system, of which grade 4 and 5 defined as major histological response (MHR), and grade 1 to 3 as non-major histological response (NMHR). The tumor's longest diameters and volumes in MHR were compared with those in NMHR by Mann-Whitney U test before, after the second and fourth cycle of NAC. Concordance correlation coefficient (CCC) were assessed to evaluate the agreement between the two method. Receiver operating characteristic curve (ROC) analysis was carried out to assess the clinical value of tumor size and the change rate.Results Before,after the second and the fourth cycle of NAC, the difference of tumor's longest diameters and their first change rate between MHR [(2.75±1.16) cm,(2.19±1.07) cm ,(1.58±0.75) cm and (21.70±15.09)%]respectively,and NMHR [(2.71±1.10) cm,(2.33±0.90) cm,(2.01±0.94) cm and (11.68±10.27)%] respectively were not significant(P>0.05). The second change rate of tumor's longest diameter in MHR [(39.00±15.38)% ] was significantly higher than that in NMHR[ (25.83±21.77)% ](P=0.04). Before, after the second and the fourth cycly of NAC, the differences of tumor volumes and their first change rate between MHR [ median 14.00 cm~3 ( range 2.96～83.41 cm~3 ) , median 7.31 cm~3 (range 0.05～55.35 cm~3), median 2.69 cm~3 (range 0～33.40 cm~3 ) , median 48.65% (range 33.64%～98.48%) ] and NMHR [median 4.25 cm~3 (range 4.78～106.55 cm~3), median 10.53 cm~3 (range 1.72～42.85 cm~3), median 7.56 cm~3 (range 0.68～156.58 cm~3), median 52.04% (range-35.79%～78.31%) ] were not significant. The second changing rate of tumor's volume in MHR [median 85.37% (ranged 27.52%～100%)] was significantly higher than that in NMHR [median 68.80% (ranged -289.60%～94.24%)](P=0.01). CCC was computed before and (0.82), after the second cycle (0.67) and after the fourth cycle (0.55), in all examinations pooled together (0.78).The second change rates of tumor's longest diameter and volume were equal to predict the final pathologic response, and the area under curve were 0.75 and 0.80, respectively (P=0.61). Conclusion The agreement between the tumor's longest diameters and tumor's volumes is good in all in breast carcinoma. The assessment efficacy of the change rate of tumor's longest diameter and that of volume were low.
